Provider Demographics
NPI:1023224797
Name:LISA L GUYOT MD PHD PC
Entity type:Organization
Organization Name:LISA L GUYOT MD PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GUYOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:810-606-7340
Mailing Address - Street 1:841 HEALTH PARK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8070
Mailing Address - Country:US
Mailing Address - Phone:810-606-7340
Mailing Address - Fax:810-606-7770
Practice Address - Street 1:3642 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8070
Practice Address - Country:US
Practice Address - Phone:810-606-7340
Practice Address - Fax:810-606-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILG063620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1402510642OtherBLUE CROSS BLUE SHIELD
MI0992728OtherHEALTH PLUS
MI4568737Medicaid
MI0992728OtherHEALTH PLUS
MI0N84710Medicare PIN